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A UK case control study found poppers use the only drug associated with HIV seroconversion. The study utilized a multivariate model of drug use. In the UK, after alcohol, nitrite inhalants are the most widely used drug among gay men. "That concurrent use of nitrite inhalants during HIV sero-discordant unprotected intercourse facilitates transmission is biologically plausible. However, an increase in risk may also be because nitrite inhalants are used to facilitate anal penetration, are more likely to be used during "rougher" sex."

The study was published in Sexually Transmitted Infections published online 14 Nov 2007. An analysis of the study is at www.aidsmap.com.

After reading the article. I don't see any facts that backs up their claim. When it says, "May" or "Could" it leads back to the "theoretical" jarkin. Yes, unprotected anal sex is high risk which is nothing new. Other than that I don't see much of a finding in their article.

Agreed...there is nothing there that I can see that proves, or even suggest, that there is a biological hiv/factor relating to poppers use. All I see there is that if you use poppers your risk level may be higher because of riskier behavior, not because of some kind of biochemical factor regarding poppers....it's more of the same hogwash as that flawed study many years ago. Poppers lower inhibitions, and thus your judgment will suffer as well, which results in riskier behavior.

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"Hope is my philosophy Just needs days in which to beLove of Life means hope for meBorn on a New Day" - John David

I might be wrong, but I think nearly all UK habitual heroin users drank plenty of milk while growing up.Children are given milk. All adult heroin users were once children. Connection? None.

People with a couple exclusive sex partners over many years might not have tried poppers while those with scores or more would be more likely to try poppers among other substances. Control groups are designed to weed out coincidences, and discover causal relationships. There is nothing here scientifically whatsoever.

A two step statistical process was used to rule out/minimize coincidences in this case control study.

STEP ONE: variables found to be associated with HIV seroconversion(univariate analysis):

unprotected receptive anal intercouse with partners not known to be HIV-negative;unprotected insertive anal intercourse with more than one man;a diagnosis with gonorrhea;rimming another;being fisted;use of the Internet to meet men;any use of nitrite inhalants.

Well, very well then. That sounds to me like it's just saying two things...

(1.) Queens like to bareback. (What a revelation that is.)

(2.) There aren't as many true Crackolinas like myself out there once caught up in meth madness and all that...but most of'em still dig the occasional whiff of some good poppers now and again to get their groove on.

My reading of the report (rather than just the aidsmap outline) sees no content that validates any of the bizarre and largely discredited, outlandish and unsupported claims made on sites such as http://www.poppers.cfsites.org .. and since that link is given, I sort of assume that we are supposed to conclude that it does provide that validation.

Read the study properly and I think you will see that whilst the researchers say that the theory that poppers could increase biological susceptibility to infection Ė by either suppressing immune function or increasing uptake of body fluids - may perhaps be plausible .. they also seem to me to be very clear about saying that they consider such a link to be highly improbable.

Take out that improbable factor and you are left with the conclusion that poppers facilitate rougher and more experimental forms of sex. So what? .. so do any number of other factors and common substances that havenít even been examined by the study.

So what if the majority of paltry seventy-five subjects with a (then) recent positive HIV test result, who completed a computer assisted self-interview, admitted to using poppers? All that tells us is that poppers are a common and readily available catalyst .. and that isnít exactly earth shattering news.

The reasons for why other substances donít stand out can quite easily be explained by the facts that:

poppers are a cheap catalyst

relatively few gay men actually use illegal drugs with any regularity (you may disagree, but I donít call a few times a year regular use)

so many people use alcohol that out of a sample of 75 you are unlikely to find more than one or two who donít use it regularly (making any statistical analysys impossible)

Now, since the study seems to say that poppers probably do not cause suppression of immune function, or an increase in the uptake body fluids; we should perhaps take Kevin Fentonís CDC credentials as a sign that this conclusion has some weight to it .. which is, I suspect, not quite what smoothstone wanted us to read into his connection with the study

Poppers aren't the problem. It is what people are doing when they have the bottle rammed up their nose.

Hell if there was any connection between popper use and HIV I would have been infected in the late 80's and probably dead by now. I can remember after a night of clubbing and dancing to great music (songs that actually had a tune) and holding a bottle to my nose for what seemed like hours I would wake in the morning with blue lips and a horrible headache. That continued for several years. I wasn't infected until the past few years, after many years of non to minimal use of poppers. (which by the way are nothing like they used to be)

Woods

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"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it." Nelson Mandela

My reading of the report (rather than just the aidsmap outline) sees no content that validates any of the bizarre and largely discredited, outlandish and unsupported claims made on sites such as http://www.poppers.cfsites.org .. and since that link is given, I sort of assume that we are supposed to conclude that it does provide that validation.

The published study states: "That concurrent use of nitrite inhalants during HIVsero-discordant unprotected intercourse facilitates transmission is biologically plausible. However an increase in risk may also be because nitrite inhalants are used to facilitate anal penetration, are more likely to be used during "rougher" sex."

There are no "nots" and dismissal of the biological plausibility. That is your dismissive analysis, not the researchers.

Dr. Fenton's authorship is interesting to me because I had spoken to him in SF about the resurgence of poppers use ...at least the large EXPLORE Study found high use...baseline 37% rising to 52% at study end...He said the Terrence Higgins Trust folks had earlier considered focusing on poppers in the past but had decided to prioritize other issues. This study, and another of their own(unpublished, but posted in their newsletter)...see www.tht.org.uk, and the results of the large SIGMA survey have resulted in prioritizing educating gay men that poppers use increases susceptibility to HIV infection. This is news.

That poppers are immunosuppressive is new information for some users. Others have dismissed the immunosuppression research for a variety of reasons. Others have accepted the research but have decided to continue to use poppers.In the case of poppers there are compound risks; so, even if the effect on the immune system is dismissed, other risks remain. My goal is to increase awareness about the research and the risks among the gay community,HIV+,HIV-,HIV?, the HIV service providing community and the HIV researchers and funders. Prevalence of use and the cumulative research to date warrants a closer look at this widely promoted product.

The association of HIV denialists and poppers is not reason enough to avert attention to poppers use,nor is the existence of a subset of gay men who will continue to use them independent of whatever the research shows.

The hostility to publicizing research about poppers is not new and is predictable. What is new is the Terrence Higgins Trust in the UK prioritizing a new focus on poppers and their potential role in HIV transmission. The published study will generate more attention to poppers independent of my efforts.

As for http://www.poppers.cfsites.org the feedback is mostly positive. The site is a listing of published research which supports the claim that poppers use effects the immune system and is a risk for HIV and HHV8 infections. There are links illustrating support in the HIV prevention effort to focus on poppers use. The site will update as developments surface.The feedback in this forum was the catalyst to get the board up. Thanks for that. Hank

However an increase in risk may also be because nitrite inhalants are used to facilitate anal penetration, are more likely to be used during "rougher" sex."

couldn't nitrate inhalants be replaced with alcohol, drugs prescribed or illicit, and even LUBE? So shouldn't studies be done on the role those things play in transmission of HIV and advise not using them.

Isn't the only way to become infected is through transfer of bodily fluid, regardless of the strength of one's immune system?

Just wondering,Woods

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"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it." Nelson Mandela

I believe the correct reading of this study is that HIV-negative gay men who use poppers for unprotected anal sex with people of unknown or different HIV antibody stats are more likely to end up HIV-positive (and alcohol use it too common and drug use to rare to get a good statistical results) <<< work out which is the key risk factor ... this train of thought might i-- with development -- lead somewhere interesting & deep in terms of understanding gay men's thinking around society, sex, validation, pleasure, health, risk and responsibility but, alas, I doubt it.

All exposures to HIV do not result in infection. Nor does all popper use result in unsafe sex. Some popper use may be more immunosuppressive than others: for example its not known if one hit of poppers effects the immune system the same as 3 hits, or 7 hits, or more. There is a spectrum of poppers use and some of these questions remain to be researched. We have Congress's mandated human study, by Elizabeth Dax '88 and '91 publications, and then NIDA reverted back to mice studies. The effects of poppers on the immune system is far from definitive. Many more questions than answers. questions have been asked about quantity of use, frequency of use? Another human study of poppers effect on the immune system, hiv viral load, hhv8 viral load, etc, like Donald Abrams at UCSF did on marijuana might answer some of the questions. In the meantime we have some limited clues.

As for your history of poppers use and not getting infected, I don't know. Most smokers, including some very heavy smokers, never get lung cancer, but a subset do and its related to smoking. And of those who do get cancer the quantity and duration of smoking increases the risk. We still caution folks about smoking even though all smokers don't get lung cancer. That non smokers also get lung cancer doesn't negate the risk of smoking.

As for the other drugs, the study looked at the other drugs and in the limited numbers studied you could not substitute the other drugs and find the same association that poppers had with infection. Hank

as for bodily fluids transmitting the virus. Yes. In a discordant partner study, with one partner HIV+and one HIV-, those positives with higher viral loads were more likely to infect their partners. All partners in the study were exposed. Those with undetectable and low viral loads were less infective. There were some negatives exposed by partners with high viral loads who didn't get infected. Risk factors for infection seem complex. But there are clues to guide us. And we revise the clues overtime. Hank

I believe the correct reading of this study is that HIV-negative gay men who use poppers for unprotected anal sex with people of unknown or different HIV antibody stats are more likely to end up HIV-positive

ahhhh, now that is something different entirely. But wouldn't unprotected anal sex be the kicker here? With or without poppers not using condoms for anal sex are going to shoot the odds way up there. Of course using the poppers might cause someone to become more "in the moment" and not worry about protection, but couldn't the same be said for drugs and alcohol or a very persuasive top.

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"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it." Nelson Mandela

What is new is the Terrence Higgins Trust in the UK prioritizing a new focus on poppers and their potential role in HIV transmission.

That is strange, because I actually happen to work with THT on the frontline of educating high-risk groups and I can assure you that whilst we may be warning about what you can end up doing under the influence of poppers (amongst many other substances), we are absolutely not telling anyone that poppers increase BIOLOGICAL susceptibility to infection with HIV (although the possibility is mentioned).

Poppers can make you feel horny, lower your inhibitions and make orgasms feel stronger. Because they relax the sphincter (the muscle in the arse hole) poppers can make it easier to be fucked or fisted. They can cause a man to lose his hard-on too.

Research shows poppers might play an important role in HIV being passed on. The reasons could be:

ē poppers can lower inhibitions, making unsafe sex more likelyē thereís a bigger risk of the arse bleeding (poppers expand blood vessels inside the arse)ē and/or poppers might make the immune system weaker for a short time, so that people are more open to infection

Itís thought the biggest risk of HIV being passed on is when an HIV negative man uses poppers when fucked without a condom by a man with HIV.

.. and far from being prioritized, that message is actually toned down from what it said in older literature.

PS: The fact that there is a brand new poppers booklet doesn't indicate a priority either. All twelve booklets in the series (speed, acid, cannabis, ketamine, poppers, alcohol, ecstasy, viagra, steroids, GHB, crystal meth and cocaine) are newly updated as part of a £250,000 programme of information on mixing drugs and alcohol with sex and HIV generally.

I'm interested in seeing the older version of THT's message on poppers that had a stronger characterization. I've not been able to locate it yet.

I agree that using the word "priority" was mistaken. "attention", "focus on", "consideration of" are better. People should be informed of the immunosuppression research and the plausible biological implications.

The Terrence Higgins Trust newsletter 12 ISSUE September 07 Section "Number Crunching":ppopers:New British research suggests that sniffing poppers during sex makes HIV infection more likely. The newsletter presents the study that was published in Sexually Transmitted Infections and interviews Neil MacDonald.

"How do the researchers interpret this? Neil MacDonald from Imperial College stresses that this isn't the first study to suggest a link between poppers and HIV seroconversion in gay men. "Numerous studies have found this association, but the tendency is to discount it because using poppers is so closely bound up with anal sex. Only by quantifying their use during high risk sex have we been able to start to untangle the relationship." "There are a number of factors that might explain this relationship, "Neil explains. "There may be a biological mechanism where poppers help HIV to enter the bloodstream; their use may facilitate greater risk(rougher sex and ejaculation);or perhaps poppers are just used by men who are having rougher sex anyway. Whichever it is, there is something going on."

In the discussion section of the published study: "While the potential of nitrite inhalants as a transmission facilitator has been acknowledged in England's MSM HIV prevention strategy it has not been adopted as a programmatic target. This study suggests that this should be considered especially in light of the data suggesting that, after alcohol, nitrite inhalants are the most widely used drug among gay men in the UK. We therefore conclude that the attributable risk of nitrite inhalanats to HIV sero-conversion among gay men in the UK is high and that reduction in their use during HIV sero-discordant unprotected intercourse be adopted as a population level goal/objective by prevention programmes. This recommendation requires further research on the needs associated with avoidance of nitrite use during HIV sero-discordant unprotected anal intercourse, and the interventions which may address these needs."

Potential biological mechanisms are multiple: vasodilation resulting in expanded blood vessels which may increase likelihood of bleeding and of the virus entering the bloodstream/body;immunosuppression increasing susceptibility to infections;more tears, abrasions as a result of rougher sex, or a different kind of sex - allowing viral entry into body;other potential biological mechanisms???

Should gay men be informed of the research showing that poppers are immunosuppressive? and that there are plausible biological mechanisms which can increase susceptibility to HIV infections? The research gives us clues and it helps if people are informed. The immunosuppression research has been accumulating for over 2 decades. Finally, there is inclusion of biological plausibility in the discussion. This is progress. Long overdue. There is something going on with poppers. There may be multiple things happening simultaneously which explains the "compound risk" label.

Research shows poppers might play an important role in HIV being passed on. The reasons could be:

ē poppers can lower inhibitions, making unsafe sex more likelyē thereís a bigger risk of the arse bleeding (poppers expand blood vessels inside the arse)ē and/or poppers might make the immune system weaker for a short time, so that people are more open to infection

Itís thought the biggest risk of HIV being passed on is when an HIV negative man uses poppers when fucked without a condom by a man with HIV.[/i]

Now this is something that I think would be hard to argue.

Thanks vokz!

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"Let us give pubicity to HV/AIDS and not hide it..." "One of the things destroying people with AIDS is the stigma we attach to it." Nelson Mandela

• and/or poppers might make the immune system weaker for a short time, so that people are more open to infection

...I would...

Chronic intake of a toxin, eg poppers, smoking, could result in immune activation, therefore more of the right sort of cells in circulation to get attached to HIV. This is not really the immune system being "weaker". Highly theoretical this kind of point, and I wonder if it is important enough to study compared to, for example, finding an effective microbicide or prevention technology that does not depend so much on end users' behavior for success (like condoms do).

But "immune system weaker" seems a fair bit of copy for a health leaflet, immune activation being an alien idea to most people.

The real issue is that people are having unprotected sex. The act of unprotected sex is in itself still a much riskier activity than sniffing poppers is, so it isnít exactly as if the results of that sort of research is going to persuade anyone to change their behaviour .. and for that reason I would consider any such research to be a shameful waste of finite resources.

Surely it would make far more sense to invest the time and money in something productive.